Prognostic Determinants in Duodenal Injuries

Blocksom, Jason M.; Tyburski, James G.; Sohn, Richard L.; Williams, Mallory; Harvey, E.; Steffes, Christopher P.; Carlin, Arthur M.; Wilson, Robert F.
March 2004
American Surgeon;Mar2004, Vol. 70 Issue 3, p248
Academic Journal
A retrospective review of 222 consecutive patients with duodenal injuries admitted to an urban Level 1 Trauma Center who subsequently underwent laparotomy during the period July 1980 to April 2002 was performed in an effort to elucidate factors associated with mortality, infectious morbidity, and length of stay in these patients. Predictably, the patients were predominantly male (92.7%) and young (mean age, 31.6 years). The overall mortality rate was 22.5 per cent, with a mortality rate of 18 per cent seen in the first 48 hours. Penetrating trauma was suffered by 88.3 per cent of the patients. Multivariate analysis revealed the performance of a thoracotomy, initial emergency department (ED) systolic blood pressure (SBP) <90 mm Hg, final operating room (OR) core body temperature less than 35° C, and presence of a splenic injury to be the most important predictors of mortality (all P < 0.05). Mortality in the patients undergoing a resuscitative thoracotomy was 88.9 per cent versus 13.3 per cent in those patients not requiring thoracotomy. An initial SBP in the ED <90 was associated with a 46 per cent mortality rate, as compared with 4 per cent in those patients not in shock. A final OR core body temperature of less than 35° C led to a 60 per cent mortality rate versus 8.3 per cent for warmer patients. Patients with a concomitant splenic injury were noted to have a 62.5 per cent mortality rate; those without had a 19.4 per cent mortality rate. The mean length of stay among survivors greater than 48 hours was 16.0 ± 24.7 days. Univariate analyses revealed lowest OR core body temperature below 35° C, initial OR SBP <90, presence of infection, >5 transfusions, initial ED SBP <90, final OR core temperature <35° C, colon injury, spleen injury, and an injury severity score (ISS) >25 all to be significantly associated with increased length of stay. Multivariate analysis revealed an initial operating room blood pressure of le...


Related Articles

  • The Assessment of Different Combination Prosthetic Repair Techniques and Prognostic Criteria for Early Wound Complications in Median Incisional Ventral Hernias. Golovin, R. V.; Nikitin, N. A. // Medical Technologies in Medicine / Sovremennye Tehnologii v Medi;2015, Vol. 7 Issue 2, p105 

    The aim of the investigation was to compare the results of using different techniques of combined prosthetic repair in median incisional ventral hernias, and develop the assessment criteria for the risk of postsurgical wound complications. Materials and Methods. We studied the effect of four...

  • Management of Descending Duodenal Injuries Secondary to Laparoscopic Cholecystectomy. Testini, Mario; Piccinni, Giuseppe; Lissidini, Germana; Di Venere, Beatrice; Gurrado, Angela; Poli, Elisabetta; Brienza, Nicola; Biondi, Antonio; Greco, Luigi; Nacchiero, Michele // Digestive Surgery;2008, Vol. 25 Issue 1, p12 

    Aim: To report our experience of managing patients affected by descending duodenal injuries secondary to laparoscopic cholecystectomy and to review the literature. Methods: Analysis of 5 cases of descending duodenal injury as a consequence of laparoscopic cholecystectomy managed between June...

  • Major abdominal surgery in the over-eighties. Palmer, C. A.; Reece-Smith, H.; Taylor, I. // Journal of the Royal Society of Medicine;Jul1989, Vol. 82 Issue 7, p391 

    We report a prospective controlled trial looking at the outcome of major abdominal surgery judged on the ability of patients to return to their preoperative activity level. Eighty patients were included in the study. Forty of these were over 80 years old and the remainder in the age group 40-65...

  • Closing midline abdominal incisions. Israelsson, Leif; Millbourn, Daniel // Langenbeck's Archives of Surgery;Dec2012, Vol. 397 Issue 8, p1201 

    Background: The most important wound complications are surgical site infection, wound dehiscence and incisional hernia. Experimental and clinical evidences support that the development of wound complications is closely related to the surgical technique at wound closure. Results: The suture...

  • Development of Abdominal Wound Dehiscence After a Colectomy: A Nursing Challenge. Johnson, Clunie M. // MEDSURG Nursing;Mar/Apr2009, Vol. 18 Issue 2, p96 

    Abdominal wound dehiscence is associated with prolonged hospitalization, high morbidity and mortality rates, an increase in health care costs, and risk of further surgery. A case of wound dehiscence in a patient following major abdominal surgery is reviewed and a framework for understanding...

  • Major abdominal operations on patients aged 80 and over: an audit. Pollock, A.V.; Evans, Mary // British Medical Journal (Clinical Research Edition);12/12/1987, Vol. 295 Issue 6612, p1522 

    Examines the rates of death and complications in patients aged over 80 after major abdominal operations in North Yorkshire, England. Cause of deaths; Similarity of mortality rate of men and women; Risk factors in operating the aged people.

  • Management of duodenal injuries. Khan, Mansoor A; Garner, Jeff; Kelty, Clive // Trauma;Jan2012, Vol. 14 Issue 1, p3 

    Injuries to the duodenum pose a diagnostic and therapeutic challenge to the surgeon. Due to the intra- and extra-peritoneal location of the duodenum, the presentation can be overt or occult, and delay in diagnosis is associated with an increased mortality rate. A range of interventions have been...

  • Diagnostic and therapeutic proceedings in cases of duodenum injury concerning an example of a post-traumatic duodenum rupture -- a case study. Maciaszczyk, Piotr; Drozda, Rafał; Ziemniak, Piotr; Cielecka, Justyna; Cywiński, Jacek; Janowski, Konrad; Kołomecki, Krzysztof // Polish Surgery / Chirurgia Polska;2008, Vol. 10 Issue 1, p58 

    Injuries occupy third place among the causes of death in the total human population, just after cardiovascular system diseases and cancer. They constitute the most common cause of death in the group of people aged up to 40. A case of post-traumatic duodenum rupture is presented, which was...

  • Treatment outcomes associated with surgery for gallbladder cancer: a 20-year experience Ito, Hiromichi; Matros, Evan; Brooks, David C.; Osteen, Robert T.; Zinner, Michael J.; Swanson, Richard S.; Ashley, Stanley W.; Whang, Edward E. // Journal of Gastrointestinal Surgery;Feb2004, Vol. 8 Issue 2, p183 

    The aim of this study was to evaluate contemporary outcomes associated with the management of gallbladder cancer. The medical records of 48 consecutive patients with gallbladder cancer treated at our institution from January 1981 through November 2001 were reviewed. Survival was analyzed using...


Read the Article


Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics